to recognize/respond to nonreassuring fetal status,

failure to do a timely delivery, failure to conduct a

proper resuscitation, failure to prevent and manage

shoulder dystocia, negligence with a vacuum or for-

ceps, and improper use of Oxytocin.

As a large health care system in NorthTexas we have

a diverse patient and sta¡/provider population. Ele-

ven entities provide OB services to small rural and

large urban communities. Nursing sta¡ £oat from

small to large facilities, and we saw the need to stan-

dardize recognition and response to management of

OB emergencies within our system. We also recog-

nized that smaller facilities could bene¢t from the

educators and resources available at the larger hos-

pitals. In addition, it was clear there was a need to

have all sta¡ nurses trained to interpret fetal moni-

tor strips using the same language and to have

physicians use this language. The program started

with nurses and physicians collaborating to create

a system wide guideline for training of sta¡ and

recommended management of emergencies. After

the guideline was approved and implemented, we

received funding from the hospital foundations to

purchase patient simulators to enhance the learn-

ing experience and to elevate the skill of the sta¡.

The goal of this project was to spread best practices

and lessons learned across the system. The project

was launched in the ¢rst quarter of 2008. The drills

are video taped, and participants are debriefed. A

summary of the debrie¢ng and lessons learned are

then shared at the entity level at the appropriate

safety/quality committees and at the system level.

There have been eye-opening results: determining

that not all operating rooms were equipped with

Code Blue pull stations, dose amounts and routes

for Cytotec for postpartum hemorrhage were

inconsistent with evidence-based literature recom-

mendations, nursing sta¡ were surprised at how

muchmore di⁄cult it was to compress and ventilate

the simulator than it was the cardiopulmonary

resuscitation chest, logistics of getting from one

£oor to another when the OR is on a di¡erent £oor,

and the need to educate supporting departments

about mock codes and the simulator.

It Takes a Village to Mother the New

Mother: Development of a Support

Program to Address the Mental Health

Needs of Women along the Continuum of

Perinatal Care

Poster Presentation

The unfortunate reality in our society is that it is

okay to have a ‘‘medical’’ condition, but mental

health diagnoses often result in negative stigma. It’s

okay to have a postpartum hemorrhage, but your

ability to parent may be questioned if you have post-

partum depression (PPD). Education is required to

address attitudes and knowledge de¢cits regarding

perinatal mental health for the community and health

care providers.Women su¡ering from PPDoftenneed

medication, talk therapy to discuss psychological

struggles related to motherhood, and support from

PPD support groups to have a safe place to share

experiences with other mothers in similar situations.

The position statement, ‘‘The Role of the Nurse in

Postpartum Mood and Anxiety Disorders’’ of the

Association of Women’s Health, Obstetric, and Neo-

natal Nurses (AWHONN) says, ‘‘Health care facilities

that serve pregnant women, new mothers and new-

borns should have routine screening protocols and

educational mechanisms for sta¡ training and client

education related to postpartum mood and anxiety

disorders.’’ The development of the Postpartum Emo-

tional Support Program at Elliot Hospital supports

these initiatives. Our hospital-based perinatal mental

health support program includes components of

screening, referral, education, phone and group sup-

port, and a community-based taskforce.

Our PPD Support Group provides a safe, nonjudg-

mental forum in which mothers can share their

feelings of depression and anxiety, while bene¢ting

from social support and learning about self-care

practices to enhance their current therapy and

Cindy Cochrane, MS, RNC-

OB, WHNP-BC, Perinatal,

Texas Health Harris Methodist

Hospital Fort Worth, Fort

Worth, TX

Childbearing

Alison Palmer, RN, MS,

WHNP-BC, Maternity Center,

Elliot Hospital, Manchester,

NH

Childbearing

JOGNN 2010; Vol. 39, Supplement 1 S33

Palmer, A. I N N O V A T I V E P R O G R A M S

Proceedings of the 2010 AWHONN Annual Convention

treatment.The purpose of our multidisciplinary task

force is to develop a coordinated structure across

our health system for perinatal mental health. Some

of our goals include assisting practice settings in

establishing care pathways and protocols to guide

practice, enhancing referral resources for repro-

ductive mental health therapy, and collaborating

with our psychiatric unit and emergency depart-

ment on models of care for perinatal patients

admitted for acute psychiatric illness.

Ourorganization has also implemented an Inpatient

Postpartum Depression Risk Assessment Program

to provide universal screening of all new mothers

for risk factors that may predispose them to post-

partum depression. An 11-item self-assessment

questionnaire is distributed to every new mother af-

ter birth. This screening tool identi¢es risk factors

and does not indicate that a woman will de¢nitely

experience PPD. Moms ‘‘at risk’’ view a PPD video,

receive targeted PPD education, follow-up phone

calls at home, are o¡ered Visiting Nurse Associa-

tion visits, and invited to attend the weekly PPD

Support Group if needed.

When screening for depression in the health care set-

ting is based on clinical observation alone, 50% of

women su¡ering from depression are missed. We

cannot rely solely on clinical judgment. Obstetric pro-

viders are encouraged to screen for depressive

symptoms with a validated tool such as the Edinburgh

Postnatal Depression Scale during follow-up visits. If

women become aware of the factors that can poten-

tially make them vulnerable to PPD, they can mobilize

their support network and make use of available re-

sources. By screening universally, we hope to reduce

the stigma of perinatal depression by encouraging

health care providers to talk about it as a common

complication of childbirth.

The Mother/Baby Reunion Project:

Ensuring Timely Reunion After

Cesarean Birth

Poster Presentation

The Mother/Baby Reunion Project was a prac-

tice improvement pilot project carried out

during June and July 2009 at The Women’s Place

at the University of Virginia Health System. It was de-

signed and implemented by the authors (project

team) as a master’s capstone project at the culmi-

nation of the Clinical Nurse Leader program at the

University of Virginia. Baseline data collected by

the project team indicated that birth to reunion time

after Cesarean delivery was 3 hours 7 minutes for

the ¢rst quarter of 2009.

According to the Centers for Disease Control and

Prevention (CDC), the national Cesarean delivery

rate in 2006 was 31.8% and has been climbing

steadily. Research shows that Cesarean delivery is

negatively associated with initiation and quality of

breastfeeding and can be considered a risk factor

for impaired breastfeeding. This indicates that wo-

men who deliver via Cesarean require greater

support in their desire to breastfeed. Best-practice

guidelines indicate that breastfeeding should be

initiated within the ¢rst 2 hours of life. Cesarean de-

livery presents barriers to early mother/infant

bonding as well as true patient- and family-cen-

tered care. The Mother/Baby Reunion Project set a

goal of reuniting healthy mothers and infants within

2 hours of birth by Cesarean delivery.

After consulting with nursing and medical leader-

ship the team settled on two work process interven-

tions to achieve this goal. The ¢rst was to initiate a

call from the operating room or the post anesthesia

care unit (both located within The Women’s Place)

to the newborn nursery when the mother left the

operation room so that the infant could be brought

tomeet the mother in recovery.The second involved

piloting new protocols that allowed infant baths

and radiant warming to be postponed in favor of ex-

pediting the reunion with the mother. Although

these new protocols were not strictly mandatory,

they were explicitly supported by the unit leader-

ship. E-mails and £yers announcing the project

were sent at the outset. The project team attended

Sara Read, MSN, The

Women’s Place, University of

Virginia Health System,

Charlottesville, VA

Lindsey Baskette, MSN, The

Women’s Place, University of

Virginia Health System, Char-

lottesville, VA

Childbearing

S34 JOGNN, 39, S19-S41; 2010. DOI: 10.1111/j.1552-6909.2010.01119.x http://jognn.awhonn.org

I N N O V A T I V E P R O G R A M S

Proceedings of the 2010 AWHONN Annual Convention